September 14, 2021

Health Care, Reproductive Health, Reproductive Justice, Sex Ed

By Isabelle Christie, Special Contributor to Maine Family Planning

On my first day of sixth grade, my mother gave me a gift: a small, floral pouch with two pads secured in pink wrapper. “Keep this in your backpack,” she told me, “for when you get your period.” Though this is all my mother said, the pouch carried with it important messages –– be prepared to cover up evidence of your menstrual cycle; don’t let anyone see you carrying a pad into the bathroom.

When my period arrived a few months later at school, I abided by those messages, moving swiftly to the bathroom and carefully unwrapping my pad so others would not hear. Still, even with the protection of a pad, I constantly feared bleeding through my pants or onto my sheets at night. The thought of revealing my menstrual status to my peers or family conjured immediate shame and embarrassment.

My experiences with and attitudes toward menstruation are not unusual for menstruating adolescents. According to a 2019 study, 71% of teens feel self-conscious on their period while 80% feel that there is a negative association with periods –– i.e. that they are “gross or unsanitary.”

These findings are unsurprising given the stigma attached to menstruation. Today, we are still encouraged to use euphemisms like “aunt flo” or “time of the month” when referring to periods. Meanwhile, many tampon and pad commercials continue to showcase product absorbency with blue (rather than red) liquid. These are only a few examples of the way in which the menstrual taboo persists.

If we are ever to eradicate menstrual stigma, we must focus on how we talk about and teach menstruation to young people, both in school and at home. Below, I detail specific content areas and vocabulary that educators and parents should keep in mind when discussing menstruation. The hope is that this advice will encourage people to not only focus on the biology and anatomy of menstruation but also to prioritize normalizing periods and fostering positive (or at least neutral) sentiment among boys, girls, and gender-nonconforming youth in their menstrual discussions.

Menstrual education should not be limited to only female-identifying youth. Splitting up a middle school health education class into “boys” and “girls,” for example, reinforces menstruation’s status as an off-limits, secretive topic. It also threatens to isolate trans boys who menstruate or cause anguish among students who feel they don’t fit into a traditional gender category.

In talking openly about menstruation to all youth, we can normalize the subject and dispel pervasive menstrual myths. For instance, it is important to emphasize that periods are not dirty, unhygienic, or gross but an essential biological function for people with uteruses. Moreover, while periods may lead to a flux in emotions, they do not make menstruators “crazy” nor any less capable than their peers. Communicating this knowledge will challenge the idea that when people PMS or menstruate they are overly volatile, irrational, and angry. More importantly, it can help prevent future generations from weaponizing periods as a way to deny menstruators positions of power in the work force and politics.

Discussing menstruation with every child also has the potential to ignite greater sympathy among non-menstruators. If young people understand what menstruation is––and isn’t––as well as the pain and discomfort that often comes along with it, they are less likely to use periods as a source for teasing.

In addition to including non-menstruators in the conversation, inclusivity also means shifting the language we use when talking about menstruation. Not all women menstruate (e.g. post-menopausal women, women dealing with health challenges, trans women) and not only women menstruate (e.g. trans men). Thus, in the classroom and at home, we should use terms such as “people who menstruate” or “menstruators” rather than “women” or “girls.” Maine Family Planning’s Puberty Happens provides examples of how educators can incorporate this sort of language into their lessons.

The “Fifth Vital Sign”
In recent years, more and more doctors have emphasized menstruation as a key indicator of health among people with uteri. A 2019 reaffirmed committee opinion written by the American College of Obstetricians and Gynecologists, and endorsed by the American Academy of Pediatrics, encourages clinicians to treat periods as a “fifth vital sign” for “girls and adolescents.” Authors of the opinion stress that menstrual abnormalities (like irregular periods or excessive bleeding) can be the first indicators of a health issue, such as polycystic ovary syndrome (PCOS), uterine lesions, eating disorders, or malnutrition.

Outside of the medical field, this terminology could be useful when educators or parents first introduce menstruation to middle schoolers. Describing menstruation as a fifth vital sign could help engender greater appreciation for periods –– rather than dreading or fearing them, young people could see periods as a sign of their well-being. At the very least, this description would show that periods are simply another biological marker of one’s health, not unlike temperature, blood pressure, respiration rate, or pulse rate.

Menstrual Pain
Given the importance of menstruation to one’s health, it is important for menstruators to speak up if they feel their periods warrant medical attention. Stigma, however, often discourages menstruators from discussing their periods with friends, family, or health care providers. This includes talking about period pain. The societal message sent to menstruators is to “suck it up” and push through menstrual discomfort without complaint. However, in some cases, this attitude can have dangerous health consequences.

An estimated 2-10 percent of reproductive aged women are affected by a condition called endometriosis, which occurs when tissue present inside of the uterus grows outside of it. This condition can lead to chronic abdominal pain, intense pain while menstruating or having sex, difficulty getting pregnant, and in rare cases ovarian cancer (Mayo Clinic, 2018).

Despite the physical symptoms that arise from endometriosis, some menstruators may not be aware they have it. Those who suffer from the disorder often dismiss their pain as “normal” period pain. Moreover, menstruators may hesitate to seek medical advice given that they have been socialized to brush their discomfort under the rug.

Even when menstruators do reach out, health-care providers are not always well-trained on menstrual conditions like endometriosis; they may gaslight patients or dismiss their pain as primary dysmenorrhea. Because of the lack of awareness and knowledge of endometriosis in the medical field, it takes menstruators an average of 7-10 years to receive a diagnosis.

Introducing menstrual disorders such as endometriosis, uterine fibroids, or PCOS to adolescents at the high school level will allow young menstruators to identify abnormal symptoms and empower them to advocate for themselves at the doctor’s office. With more menstrual knowledge, they can garner greater agency over their bodies and the ability to make informed choices about care rather than displacing authority onto medical experts.

While menstrual disorders, which are inherently complex in nature, may not be an appropriate topic for middle schoolers, it is still important for educators and parents to normalize period pain and make clear that it is okay for menstruators to express their discomfort –– the reality of periods is not always glamorous. Teaching all youth about period pain will likely give rise to greater sympathy for menstruators and could pave the way for more forgiving workplace policies (e.g. menstrual leave, more time off) in the future.

Beyond Biology
To normalize menstruation and its public discussion, we should consider incorporating it into educational areas beyond health and reproduction. Menstruation can be connected to a wide range of issues –– poverty, gender equity, trans rights, global warming, and more. Teachers should consider how they might emphasize menstrual issues in their courses. Environmental science classes, for example, could address the environmental harms of disposable menstrual products and point to more eco-friendly options like cups, reusable pads or period underwear. English teachers might choose books containing menstrual scenes and dialogue like Carrie, Ulysses, Go Set A Watchman, or Anne Frank’s Diary of a Young Girl with the intent to address such content in class discussions. A global studies course or current events lesson could cover period poverty and menstrual inequity in the United States and worldwide. By including menstruation in a variety of subject areas, teachers can help destigmatize the topic while also making our youth more informed, global citizens.

While it can take some time to influence curriculum changes in schools, especially as it pertains to health education, teachers, nurses, parents, guardians, coaches, and siblings still have the ability to shape attitudes toward menstruation among our youth. By talking openly about periods, and keeping the above advice in mind, we can help chip away at menstrual stigma––and in turn gender inequity––and create a society in which menstruators are empowered, rather than held back, by their periods.